MORAL TREATMENT

At a 19th-century psychiatric hospital, a patient and the superintendent travel parallel journeys toward greater peace.

“Pure food, adequate rest, wholesome influences, wholesome occupations” are the abiding principles of “moral treatment,” a novel approach to the care of the mentally ill pioneered by the real-life Thomas Story Kirkbride in the mid-19th century. At an immense hospital in northern Michigan built and run according to Kirkbride’s beliefs—which will be familiar to readers of Jayne Anne Phillips’ Night Watch (2023), set in a similar location—a 17-year-old named Amy Underwood has arrived for treatment in 1889. Diagnosed as insane by two doctors, she is in fact a lonely, alienated young woman whose encounter with a threatening group of lumberjacks left her traumatized. One of the few young people at the hospital, she struggles to establish connections and, after stealing a photograph belonging to the superintendent’s wife, finds herself demoted in the hierarchy of wards and care. Carpenter’s carefully detailed, subtly observed novel is in part a survey of the hospital. Through the eyes of the elderly superintendent, referred to only as James, the reader learns much about methods and means, staff and patients, and various aspects of illness and treatment. James is weary and overburdened. Amy is secretive and misunderstood, although friendship with another young inmate, volatile Letitia, opens her up somewhat. Intrigues involve other doctors, officials, and visitors. James’ wife also plays a crucial role, offering firmness, compassion, and new perspectives to both central figures. She also contributes to the novel’s feminist subtext, which considers the imbalance of confident, empowered men controlling women via social as well as medical norms. There are no simple resolutions for Amy or James, yet the ground has slowly shifted for both.

Sober, sometimes dry, yet an affecting story of the potential for growth.